Hazard Recognition

A recently published OSHA technical document entitled, "Controlling Occupational Exposure to Hazardous Drugs" provides updated the scientific literature on hazardous drugs. For some years, NIOSH, the FDA, and OSHA undertook a bi-ennial review of old and new drugs, classified them in a consensus process to their degree of hazard and usability, and posted that list through a systematic process. The most recent list is posted in the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2014.

Healthcare workers may be exposed to other agents and classes of agents with similar effects, like waste anesthetic gases in the operating room, in recovery rooms, and in dental offices.

Exposure assessment for hazardous drugs remains controversial. The review above outlines current limitations, and NIOSH has webpages both on biological monitoring and exposure assessment.

The following references aid in recognizing and controlling hazards associated with hazardous drugs in the workplace.

• NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2014. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2014-138, (September 2014).
• Yodaiken RE, and D. Bennett. "OSHA work-practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs." American Journal of Hospital Pharmacy 43.5(May 1986): 1193-204. Reviews the short and long-term hazards known to be associated with cytotoxic (antineoplastic) drugs and work-practice guidelines that can limit exposure to workers. [For updated and expanded information see "Controlling Occupational Exposure to Hazardous Drugs" below.]
• Occupational Exposure to Antineoplastic Agents and Other Hazardous Drugs. National Institute for Occupational Safety and Health (NIOSH) Workplace Safety and Health Topic.
• Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings: Appendix A - Drugs Considered Hazardous. U.S. Department of Health and Human Services (DHHS), National Institute of Occupational Health and Safety (NIOSH) Publication No. 2004-165, (September 2004). Provides an annually updated list of drugs considered hazardous.
• NIOSH Warns: Nitrous Oxide Continues to Threaten Health Care Workers. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 94-118, (June 14, 1994). NIOSH has issued a warning to medical, dental, and veterinary professionals who work with nitrous oxide (N2O). The Institute warns that even with preventive measures such as scavenging systems in place these workers may be at risk for serious health effects due to their exposure.
• Guidelines for Protecting the Safety and Health of Health Care Workers. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 88-119, (September 1988). Addresses the risks that nurses and pharmacists face from contact with pharmaceuticals.
• Drugs. U.S. Food and Drug Administration (FDA).
• OSHA Technical Manual (OTM). OSHA Directive TED 01-00-015 [TED 1-0.15A], (January 20, 1999). Although some of the chapter content is outdated, these sections are valuable.
  • Hospital Investigations: Health Hazards. Deals briefly with the hazards of anesthetic agents and antineoplastic drug exposures in the hospital setting.